One- and two-year visual outcomes from the Moorfields age-related macular degeneration database: a retrospective cohort study and an open science resource

Fasler, Katrin; Moraes, Gabriella; Wagner, Siegfried; Kortuem, Karsten; Chopra, Reena; Faes, Livia; Preston, Gabriella; Pontikos, Nikolas; Fu, Dun Jack; Patel, Praveen J; Tufail, Adnan; Lee, Aaron; Balaskas, Konstantinos; Keane, Pearse A.

doi:10.1136/bmjopen-2018-027441

Cited by 29 publications

(35 citation statements)

References 34 publications

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“…64,65 Three recent publications from the same institution had slightly different visual outcomes. 26,27,41 Some of this relates to the time-point when eyes were included, consistent with a national trend for better outcomes over time.…”

Section: Inter-centre and Intra-centre Variation In Visual Outcomesmentioning

confidence: 73%

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Mehta¹,

Kim²,

Mathis³

et al. 2020

OPTH

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Purpose: To report trends in real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) in the United Kingdom (UK) over the last decade. Design: Systematic review. Methods: Medline, PubMed, and Embase databases were searched from 9 April 2010 to 8 April 2020 for publications that met the inclusion criteria: treatment-naïve eyes, UK-only data and ≥1 year of follow-up. ICHOM (International Consortium for Health Outcome Measures) outcomes and study quality were assessed. Visual acuity (VA) trends were assessed in studies with ≥100 eyes at baseline. Results: Twenty-six studies (n=25,761 eyes) were included, meeting 14-17 out of 20 Institute of Health Economics Quality Appraisal of Case Series checklist domains. Only ranibizumab and aflibercept outcome data were available. The mean injection number in the first year of treatment was 5.9 in publications from 2010 to 2015 and 7.1 from 2015 to 2020. Average baseline VA and mean one-year, two-year and three-year VA gains gradually improved over the last decade. Longer-term studies reported that the visual gains achieved in the first year of treatment were rarely maintained, with under-treatment a likely contributing factor. Conclusion: UK real-world outcomes have improved over the last decade with improved service delivery and the adoption of more proactive treatment regimens but are still not always as impressive as registration clinical trial results. Access to longer-acting anti-VEGF therapies would reduce the treatment burden for patients, carers, and the healthcare system, potentially making replication of clinical trial results possible in the NHS.

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Section: Inter-centre and Intra-centre Variation In Visual Outcomesmentioning

confidence: 73%

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Mehta¹,

Kim²,

Mathis³

et al. 2020

OPTH

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“…Overall mean number of injections received was 52.2 over a period of 10 years. Previous studies on long-term outcomes at 1,2 5 and 7 years have all shown the reduced effectiveness of anti-VEGF agents in clinical practice and most reports have attributed these results to the reduced number of injections over time [5,6,[10][11][12][13]. Qin et al in their study on long term outcomes of exudative AMD treatment have attributed the variable results to the differences in frequency and regularity of anti-VEGF treatment [14].…”

Section: Discussionmentioning

confidence: 99%

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Chandra

Arpa

Menon

et al. 2020

Eye

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Purpose Single center, noninterventional cohort study to assess 10-year visual and anatomical outcomes following initiation of treatment with antivascular endothelial growth factor (anti-VEGF) agents in neovascular age-related macular degeneration (AMD) patients. Neovascular AMD patients initiated on intravitreal anti-VEGF injections in 2008–2009 and continued to be followed up for at least 10 years were included in this study. Methods The Moorfields OpenEyes database was searched for all patients who were initiated on anti-VEGF therapy for neovascular AMD in 2008–2009 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records were analyzed for those who have had at least 10-year follow-up. The spectral-domain optical coherence tomography (SD-OCT) scans, color fundus photos, and fundus fluorescein angiography (FA) were graded by two retinal physicians. The outcomes were also compared between those with good and poor VA outcomes based on pre-defined criteria. The primary end point was change in VA at 10 years; secondary outcomes included percentage with VA of 20/40 or better, 20/70 or better, VA gains and losses, anatomic outcomes and number of injections. Results After a mean of 10.04 years after initiation of anti-VEGF therapy, the mean decline in VA from baseline was −2.1 ETDRS letters (SD 19.9, p = 0.65). One hundred eyes (67.1%) achieved a VA threshold of 20/70 or better, 33.5% achieved a VA of 20/40 or better, and 76.5% eyes maintained VA defined as a loss of less than 15 letters. Fourteen percent of study eyes had VA of 20/200 or worse and 23.5% declined by 15 letters or more. 87.5% of eyes were switched from ranibizumab to aflibercept during the course of 10 years and the eyes received a mean of 52.2 (SD 18.1) injections over 10 years. From this cohort, 87 (58.3%) eyes are having on-going treatment. On OCT, 34.9% had persistent fluid at the last visit, 6.7% patients showed new onset atrophy compared to baseline, and 43.7% had increased area of macular atrophy. The mean area of atrophy at the final visit was 4.15 mm 2 . Comparison between the good and worse visual outcome groups showed lower baseline VA, fovea-involving atrophy and final area of atrophy had a statistically significant negative effect on the final visual outcome ( p < 0.05). Conclusions Regular monitoring and anti-VEGF treatment over 10 years reduce the risk of visual loss of 15 letters or more in patients with neovascular AMD. The most common cause of substantial visual decline was macular atrophy.

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“…As data from real-world studies suggest that patients receive fewer injections than those studied in clinical trials, the benefit seen from a TREX regime likely comes from its proactive nature, as a higher number of injections are also associated with better visual outcomes. 28 , 37 , 50 , 118 …”

Section: Anatomic Factorsmentioning

confidence: 99%

Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration – Current Perspectives

Phan

Broadhead

Hong

et al. 2021

OPTH

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Visual acuity is a key outcome measure in the treatment of neovascular age-related macular degeneration (nAMD) using anti-vascular endothelial growth factor agents. Large variations in visual responses between individuals within clinical trials and real-world studies may relate to underlying differences in patient and treatment factors. Most notably, a better baseline visual acuity, younger age and smaller choroidal neovascularization lesion size have been strongly associated with achieving better visual outcomes. In addition, there is emerging evidence for other roles including genetic factors and anatomical variables such as fluid status. Apart from patient-related factors, treatments that favor a higher number of injections tend to provide better visual outcomes. Overall, the identification of predictive factors does not currently play an essential role in the clinical management of patients with nAMD. However, they have allowed for the understanding that early detection, timely management and close monitoring of the disease are required to achieve optimal visual outcomes. Further investigation into predictive factors alongside the development of novel therapeutic agents may one day provide a means to accurately predict patient outcomes. Treatment regimens that offer flexible dosing patterns such as the treat-and-extend strategy currently provide a degree of personalization during treatment.

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One- and two-year visual outcomes from the Moorfields age-related macular degeneration database: a retrospective cohort study and an open science resource

Cited by 29 publications

References 34 publications

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

<p>Trends in Real-World Neovascular AMD Treatment Outcomes in the UK</p>

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration – Current Perspectives

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